Case Study: Four And Not Growing

Increasingly, I receive more and more e-mails from parents asking me… ME… for feeding advice. Baaaaah! I’ve read quite a bit on the topic of selective eating and I talk very openly about our struggles with food, but that certainly doesn’t qualify me as any sort of feeding expert. I’m just a mom with a selective eating child. Unfortunately, that’s pretty much all that parents of selective eating kids feel that we have to turn to for advice and support. Each other.

Doctors dismiss our concerns with, “just a picky eater”; I’ve had a dietitian recommend removing bread from the table, the only food TJ will eat; we have bewildered a well trained occupational therapist, and a pediatrician. Even the pediatric psychiatrist that finally diagnosed TJ with generalized anxiety and specific food phobia is scratching his head. We’re quite talented at confusing the experts.

Nobody truly understands what it feels like to watch your child starve themselves more than another parent faced with the same challenges. I can share what I’ve learned so far and what works for us specifically, but there are so many contributing factors that could make a child fearful of unfamiliar food, many of which I have no personal experience with.

I do, however, have a voice through this blog and I hope it’s loud enough to reach those who are qualified to offer this particular mom some help. Please!

Meet Mom:

Mom is an ABA (Applied Behaviour Analysis) therapist for children with autism. “I once worked 2 hours a day, 5 times a week for 4 months to get a girl to drink water. She was petrified of water in her mouth. Parents used to use a syringe to get water in. Eventually, I discovered that if I slathered her sippy cup with peanut butter, as she sucked it off, out came the water. I broke that goal down into a million steps! But I’m lost with my own kid.”

“Growing up with colitis, my diet was basically boiled chicken, potatoes and Ensure®. I was 18 before I ever had anything containing dairy, sugar, red sauce… My head cannot wrap itself around NOT wanting food when it’s ALL I wanted. Dr. Atkins (of Atkins Diet fame) gave me 3 “whatever you want to eat” days over the course of years. I loved those days!”

Meet Son:

Son will turn 4 in May, 2013.

He shows no signs of autism or developmental delay. No oral motor issues, no speech issues, no sensory sensitivities and no known allergies. GI evaluation checked out fine.

“His pediatrician advised us to start him on purees at 4 months because he wasn’t gaining much weight nursing. He never took to the texture. By the age of one, he was gagging at anything besides yogurt and crying at the sight of his high chair.

He attended a few sessions of feeding therapy at age 2. He spat, tantrumed, and went completely nuts. The therapist put a piece of chicken in with his preferred yogurt and I watched my otherwise typical toddler headbanging, screaming, spitting and crying to the point of vomiting. I wanted to kill myself seeing him go absolutely ballistic. That was the last of that.

At his 3 year check up, he measured 36” and 25lbs. Since then, there has been no progress in height or weight and his list of safe food is getting smaller.

His current diet includes granola bar, yogurt, banana. His main drink is a drinkable yogurt. As of 3 months ago he will eat french toast and just recently, pasta, carrot applesauce, certain dehydrated fruit, veggie chips and sometimes a scrambled egg. He seems interested in broccoli, but throws up when he eats it. Other than that, no vegetables, no meat. He has pretty much always eaten for necessity. He doesn’t “love” anything.”

What Meals Currently Look Like:

Mom spends anywhere from 3-5 hrs a day trying to feed her son, and hours waiting for him to chew and swallow. She wants to encourage him to eat by himself so she doesn’t have to feed him, especially now that she is nursing his baby sister.

“He sees broccoli and asks me to make him some, so I do. Once it’s on his plate, his whole body language gets tense. He’ll stare at it for 20 – 30 minutes. When I encourage him to try it, he puts it in his mouth, gags and barfs it up. I’m glad that he is asking, but it’s so frustrating to watch him sitting there, staring at it forever. Then I lose my patience and say, “You asked for this, did you want to eat it?” It seems to have become a game of “pleasing mommy for asking” but no intent of eating it.”

He will not eat at school because he doesn’t want his friends to know he can’t eat like them. Now he has starting declining invitations to birthday parties because of the food.

He will pocket a bite of sandwich for well over an hour. Mom has tried a token board (1 bite of chicken earns 1 choc chip), but he just pockets the food in his cheek. He has zero concept of taking bites. He shoves it all in his mouth and then spits it all out. No idea how to handle a slice of pizza, it needs to be precut into 32 squares. Same with a sandwich (16 bites), otherwise he can’t handle it. He can, however, shovel in his preferred snacks just fine.

“This summer I put him on a timer so there is a beginning and end in sight to meals. When timer goes off, I say, “Meal over”, and he goes crazy! “Noooo, I’m not done!!!!” So I let him sit longer, and he just stares at his plate. Everyone around me has been using intimidating tactics (including me in the past).”

Suggestions:

Stress, pocketing, and growth concerns. This child has never eaten without being pressured.

Mom agreed to remove as much pressure as she could. No bribes, no “this” for “that” rewards for eating, but she decided to keep the timer so Son knows the meal will eventually end. After 10 days, Mom reports:

“More progress this week. A lick of spaghetti, and a shooting peas game. Red sauce accidentally touched his cheek. Oh, man! lol!” Mom has stopped using the timer, and although there is small progress, an ongoing problem remains, “When he asks for something specific, he will stares at it for half an hour. When he finally tries it, he gags and barfs. How long is too long? What do I do?”

I shared what is working for us. “You decide what food to offer and you HAVE to include at least 2 things he has no issue with. (One food, one drink – very cool). He decides how much he wants to eat. This is served buffet style, not pre-plated. Put things out he might like to try, but the option is his to decline. Don’t encourage him to eat anything – just let him know he is free to choose. You just put eating completely in his control. Now, he can set the pace on learning how to eat. If you are worried that he is not eating enough, offer food more often. How doable to you think this is?”

Mom thinks this is very do-able, and reports on their first meal using the Division of Responsibility. “Buffet this morning went well. He picked his usual, of course, granola bar. When I told him to take whichever he wanted, he cried and wanted me to pick it up. This will take getting used to.”

13 responses to “Case Study: Four And Not Growing”

I agree with Mealtime Hostage…taking the pressure off is absolutely the way to go. Even though this child isn’t reported to have sensory issues, I still might employ sensory techniques to try to increase the child’s comfort level with foods in a safe and child-led manner. For example, include opportunities for the child to “play” with food outside of mealtimes. Get a rice table and fill it with various materials – dry rice, beans, Cheerios. Also provide other food items to play with, like cooked noodles, Jell-O, etc. Try “painting” with pudding, squishing whipped cream, and other crafts with food. Allow your child to help you cook.

However, never force these activities. Present the materials, invite the child to play, and then let the child take the lead. If he wants to taste the food he’s playing with, allow it, but don’t force it or make too big of a deal about it. Let him feel in control; you simply provide the materials and food choices and it is his decision whether to eat or not to eat and how to eat it.

My son Tyler was 17 years old last Friday…..,but there was no cake !! and I’m sure you can guess why. He has never really liked much when it comes to food,
We moved from England to Ontario Canada 12 years ago when he was 5 and his brother was 3.
He was refusing foods from the age of about 2. and now his diet pretty much consists of cereal [which he barely eats but I insist he goes to school with something in him] no lunch at school unless one of his friends drives him to Tim Hortons for a plain bagel or Mcdonalds for nuggets.
He comes home from school and makes home made french fries and maybe scoffs a granola bar.
Dinner every night is plain pasta with butter and I mean EVERY night.
He loves grapes and apples thank God .

Sadly I have no big success story I can share with you parents of younger kids and it was only last week that I even started to do research because I was as i’m sure most people are…waiting for him to grow out of it !
I tried my family doctor a few years ago and he just basically said that it was a battle and we were losing…we took him to a dietitian who told us what he should be eating to be healthy..hello we knew that already !
We tried the sitting at the table with a plate of chicken and broccoli once and when at midnight he was still there I let him go to bed…..I never did it again.

When he’s at friends houses he just tells them he’s not hungry if they offer him food and that’s the end of that and yes he will absolutely starve rather than try something new..Most of my friends accept him and even buy in things he will eat,even though i’m sure some don’t agree with it but i’m grateful for that.

I’ve endured all the comments from friends and other parents…my all time favorite being “in my house you eat what you’re given ” I’m sure many people think i’m just soft and I indulge and spoil him… but guess what….. my biggest success i feel is letting him be HIMSELF.

Does anybody really believe I wanted to make him the same sandwich for 8 years of grade school every single day,or that I don’t want to make him anything in this universe other than that same bowl of pasta and butter every single evening !! (luckily he often makes it himself now)

Of course not…but let me tell you some things about this young man.
He’s on the smaller side for his age but that’s genetics more than diet.
He is a bag of confidence and has lots of friends.
He is rarely sick even when the rest of us are in our rooms coughing and dying with the flu.
He has beautiful skin for a 17 year old …. and is an extremely good athlete with fabulous co-ordination.His grades could be better but hey he’s a 17 year old !
He never comes home late or stinking of alcohol,….maybe he’ll never like that either 🙂
He is as happy as can be and he pretty much sailed through puberty with barely 1 mood swing

Do I worry about his future…absolutely.
In our world it’s safe,nobody pressures him to eat anything he doesn’t want to….but how is a wife going to deal with this or even employers ?
Those are things he’ll have to deal with later and if there was any help for this I’d snatch it up in an instant…

I do truly believe in his heart he would like to be more adventurous with food but somehow mentally he can’t seem to do it….and also it doesn’t seem to stress him out one bit.
This is a subject never up for discussion and if I try i’m shut down rapidly.

Hi, I’m 17 and I’ve had selective eating disorder for as long as I can remember. I just wanted to tell you that I think it’s amazing how accepting you are of your son and that I’m sure he has benefited so much from this. Just knowing that if he wants to talk you will listen is something that would be useful to many SED sufferers.

I do absolutely and completely agree with everything Mealtime Hostage said. I just wanted to add that if he wants his pizza in 32 bites or his sand in 16 squares, that is ok. As he gets older that might change. But for now that is really important to him. My son is very particular about many things, some of which he has grown out of. He has sensory issues and OCD behaviour.

I find with giving him control it takes the stress out of meals. He may not be eating a variety of food, but mealtimes are not longer upsetting. He used to be so sad at mealtimes, it broke my heart. Now, it is easier for him to join us at the table and eat what he is comfortable with. In my heart of heart this is half the battle. The other half may come in time. Most important …. my son is happier.

My son is a slow eater. So, at our table, whoever is done eating leaves the table. There is no dessert until everyone is done. This stops those who eat not to rush and those who are slow feel no pressure. I will usually sit with my son for a few minutes after everyone else has left the table. Then I start clearing the table and let my son take as much time as he needs with what is on his plate. He is not “made” to eat or under any time frame. There are times when we do need to rush a bit, as we have to go to an activity. I will then get supper earlier on those days and state everyone need to be done at a certain time. Those days there is no dessert.
Slow eating was problem in the morning. I simply and casually told him if he needed more time to eat in the morning, he would have to go to bed earlier so he could get up earlier. Of course this let to quite a reaction from him! I stood my ground and after 2 days he eats in the appropriate amount of time in the morning
I was never a fan of the timer. That suggestion was presented to me a number of times by different professionals. I never used it. I thought we had enough struggles, I didn’t want to add one more.

Funny how it was also suggested to us to use a timer. We had just started (maybe just shy of a week) when we took our first ever trip to Disney World. On the 2nd night, the kids were so sad, begging to go home. When I asked what was wrong, they both replied, “There’s too many clocks here.” 😦 That was the end of the timer.

A few random thoughts, since you are asking! This sounds a lot like Amari in the book (Love Me, Feed Me http://www.amazon.com/Love-Me-Feed-Adoptive-Struggles/dp/0615691315/ref=sr_1_1?s=books&ie=UTF8&qid=1361380132&sr=1-1&keywords=love+me%2C+feed+me), do you think so (pg 114-116 journal entries), Mealtime Hostage? Amari was three, was vomiting, gagging, pocketing (all after negative speech and feeding eval who felt it was “psychological”) and not gaining weight… Do you allow your son to spit foods out? Sometimes that is a big thing people miss, or they may feel that it is rude. I recommend putting out a paper napkin and letting kids know they can always spit foods out. Once there was no pressure on Amari, within a weekend, the daily vomiting had stopped. The pocketing was more slow to go, and Amari’s mom was raised that spitting out food was rude. It took her awhile to allow that. Kids who gag or vomit need to know they don’t have to swallow to get food out of their mouth. They may be more likely to put food in. One mom wrote on an intake analysis, “…the food was still in her cheek, bc she knows I won’t put more food in there if it’s in her cheek…” They spent 4-6 hours a day in the highchair in the hopes of getting more food in. Sounds like you’re not putting food in his mouth, but found it helped to remind clients not to put food in the child’s mouth. I love the other comment about her child being happier and how you are all tuned in to your children and their reactions. You can trust that. If kids are anxious or upset, it kills appetite and makes it really hard to tune in to hungry/full or if they might be open to trying or tolerating a new food… So often what kids want is not to feel like the focus, like there is a big spotlight on their eating, which is also pressure. An adult selective eater I worked with was very sensitive to anyone even watching her eat, when she knew they had an opinion about how she ate… If a child can be a participant at a pleasant meal, where the goal is to support, not pressure, it can help. great discussion! Stickers, praise, rewards, therapy tasks, pressure, bribing etc can feel like pressure to the sensitive child and slow things down… Trust your gut!

Thanks! This past week, I’ve had clients with children who are ten and thirteen years old, who had no support, who got terrible advice, who had therapies that their children fought, or hated. One recent client told of her daughter vomiting just pulling into the therapy parking lot! I am glad you are out there. Parents need more information and support, and they need it early. It’s way easier to help when children are young, than when they are teens. There is so much more than fight, pressure and argue or just give in and serve only french toast fingers all day every day… It’s not easy. These children are challenging to feed for any number of reasons, and docs and therapists needs to get better educated about all aspects and about supporting families!